Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions here. To ask her your own question, click here.
Dear Dr. Vanessa,
Is there a safe, medical way to improve my libido? Is there a Viagra for women? I want to want it, but I just don’t. (I’m married, 40, with a kid.)
–Sparkless
Dear Sparkless.,
In the United States, lack of sexual desire is more common in women than in men. Some surveys in the last 15 years suggest that as many as one out of three women experience it some or most of the time. The causes can be complex. Often there is more than one cause. Here are a few of the possibilities:
- Situational causes: Many women have too many things to do during the day and are just too tired to entertain sexual fantasy and become aroused. Challenging stresses at work, in relationships, or in their families can also dampen sexual desire. Some women find that their potential partners are not very attractive.
- Psychological causes: Some women have sexual histories that include sex-negative family attitudes, sexual assault, sexually indifferent partners, painful intercourse, or other experiences that can inhibit sexual desire. Some women suffer from depression, which can reduce sexual desire.
- Medical causes: Certain medical conditions, like diabetes, or side effects of certain medications, like some depression medicines, can inhibit sexual desire. (When lack of sexual desire is a side effect of a medication, your health care provider may be able to prescribe an alternative medication.)
- Hormonal causes: Women may not have enough of one or both of the two key hormones associated with the sex drive in women. The first is estrogen. The second is testosterone, which is also associated with the sex drive in men. Natural or surgical menopause is the most common cause of such hormonal depletion.
Identifying the cause of lack of sexual desire is important to successful treatment. Start with your current health care provider to evaluate the possible medical or hormonal causes. To explore other causes and solutions, you could turn to a psychotherapist experienced in sexual issues or to a qualified sex therapist. The American Association of Sexuality Educators, Counselors, and Therapists has a list of certified sex therapists. Or your health care provider may be able to give you referrals.
If a woman is postmenopausal and no other causes are found, the first line of treatment is estrogen replacement therapy. If a woman has sufficient estrogen (for example, if she is premenopausal or if she is postmenopausal and is taking estrogen) and she has no other cause for lack of sexual desire, her physician may suggest trying testosterone supplements — creams, gels, injections, pills, or skin patch. This therapy has been successful for some postmenopausal women. More long-term studies are being published about potential benefits for postmenopausal women, but no testosterone product has been specifically FDA-approved to increase a woman’s libido to date. A few small studies have found testosterone may help premenopausal women, too. Whether pre- or postmenopausal, there are possible side effects to watch out for. So you and your doctor want to consider the testosterone alternative carefully.
Whatever the causes, thousands of women have found ways to rejuvenate sexual desire in their lives, and they have found that the effort it takes is very worthwhile.
Best wishes for finding a solution and for continuing good sexual health,
Vanessa
Planned Parenthood
Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.
Lady, thanks for bringing Wellbutrin up. For those, like myself, whose depression symptoms include(d) lack of libido, this medication could help out. Of course, it isn’t the best way to boost libido for all.
Camelia, I asked my GYN for testosterone for that very problem. He gave me Viagra, instead, I think I am going to basically insist on some testosterone the next time I see him. The Viagra is too damn expensive, and you have to take it an hour before you have sex, (and we don’t usually think about it that far in advance, it just happens. We also make love a LOT in the morning, My Man gets up VERY early, I’d have to set my alarm for, like 3:00 AM to take the damn blue pill at the right time. And then what if one of the kids wakes up, or he’s running late and we don’t get to? $20.00 down the drain and a VERY horny upset lady.)
I was given Estrogen creme, which I was afraid to use, because estrogen in the Pill used to really make my migraines worse, but I did anyway, the creme has had no effect on my headaches. There’s a prescription called “Estra-test” which is estrogen and testosterone, and if my GYN won’t prescribe either that or at least testosterone injections, I am going to see someone else who will do this.
I hate having to worry every time “OMG, is it going to happen? Is it going to take an hour? What if he gets bored?” ect. NONE of this is good for an otherwise great sex life. (He doesn’t get bored, but he has fallen asleep a few times, which did not make ME a happy lady.) And I love my sex toys, but don’t want to HAVE to use them every time.
It is frustrating as hell. WHY does no one talk about how perimenopause may do this to you? All I knew about (and I’m a nurse with a Master’s) was hot flashes, night sweats, “increased fat deposits” and “thinning vaginal tissue.” NOBODY said anything about “taking all day to have an orgasm, and maybe sometimes not getting to have one at all.”
As for ss’s suggestion for literature, I have found Violet Blue and Alison Tyler’s women’s erotica collections from a variety of authors to be VERY helpful. Good stuff.
Testosterone helps me have orgasms more easily. After I started going through menopause, it seemed to take forever to reach orgasm. Sensation in the clitoris seemed be down 100-fold. Testosterone brought me back to pre-menstrual sensitivity.
I was in the same boat recently (married, 46, 3 kids), use to be up for it all the time when I was younger, then kids, etc happened, and libido went out the window. I think part of the problem is that we stop thinking about sex, whereas men fantasize about it frequently. Strange but true: I found that once I started thinking about sex again, I started wanting to have it again (a lot!), and I did this by reading (brace yourself)romance novels. I’m a former English major, and previously had nothing but scorn for books like those those, but after one of my teenage daughter’s friends left a few at our house, and I picked one up out of curiosity, I was hooked! My husband said, “I don’t know what you’ve been reading, but tell me where I can buy them to keep you in constant supply.” Seriously, it’s a cheap solution/suggestion, unlike medication or counselling, give it a try! Recommended: Gena Showalter, Emma Holly, Lora Leigh, Kresley Cole to get you started. Oh, and buy some decent lube, not KY.
From what my personal GYN said to me, Viagra is only prescribed for women who HAVE a healthy libido, but are having trouble reaching orgasm. It works for some, not for others. It seems to only work for this problem when women have normal female levels of testosterone, as well.
As others have said, it doesn’t nor promote desire, just helps with blood flow to the clitoris (so it can become engorged enough to trigger and orgasm) in women who may be having climax problems due to perimenopause or certain illnesses.
As most insurance companies will NOT pay for this drug for women, (even including the ones who pay for it for men) and they cost about $20.00 or more a pill, most women in this case are out of luck, unless they are rich.
As for helping your libido, HAVING sex actually releases hormones and changes blood flow to make it easier to FEEL aroused more often. The more you do it, they more you’ll want it, most of the time. A lot of women (as long as there aren’t any significant trauma problems) find that just DOING IT more frequently will do wonders for their libido.
Britni: In Dr. Vanessa’s defense, it was the reader who mentioned Viagra casually and we (Em & Lo) just went with it because we found this funny picture (more ethereal things like libido — or a lackthereof — are hard to illustrate photographically). But thanks for the clarification!
Wellbutrin and its generic, buproprion, can help women with libido issues. It seems that anything that boosts the dopamine increases libido.
I think it’s important to clear up a common misconception about ED medications. Viagra does NOT increase libido. It helps with erectile dysfucntion. The man WANTS sex, but cannot physically get an erection. If a man with ED did not want to have sex with someone, Viagra wouldn’t make him aroused and give him an erection. He has to be aroused for that to happen.
So calling Viagra a “libido booster” is a misnomer.